c Walnut Crossing b

Membership Form and Survey

Name(s) ………………………………………………..	Phone ……………………………
Address ………………………………………………..	email ……………………………

SURVEY

Neighborhood Interests & Concerns:

Can you occassionally help with:

	Bike & Pedestrian issues			Canvassing & Membership Drive
	Balcones Park/ Walnut Creek/ recreation areas			Fundraising & Donations
	Crime / Safety / Neighborhood Watch			Legal Advice or research
	Beautification / Litter / Landscaping			Grant & Proposal writing
	Zoning & Development / Local Businesses			Website / Computer assistance
	Children’s issues / schools			Art / Fliers/ Advertising / Printing
	Public Transportation			Event Planning or Production
	Events (halloween, christmas, block parties)			City Hall relations & lobbying
				Administrative help / phoning / mailing / etc.

Do you have any specific ideas for the betterment of the neighborhood?

Do you have any specific complaints or problems you would like to see addressed?

Would you be interested in being a block captain for Neighborhood Watch? YES / NO

Would you be willing to pay annual dues to support the association and events such as this one? YES / NO If YES, then what amount would seem reasonable?

Are you able to receive Association news by email? YES / NO

If not, would you be interested in receiving printed versions by mail at an estimated cost
of $ 4.00 per year? YES / NO

Please return this form to: Walnut Crossing Association, 3600 Tyrone Drive, Austin TX 78759